This document discusses pulse wave analysis and central blood pressure. It explains that pulse wave velocity analysis can provide information about arterial stiffness and wave reflections that influence central blood pressure, which may be a better indicator of cardiovascular risk than brachial blood pressure. A study at Bahrain Specialist Hospital found that central systolic blood pressure was significantly lower than brachial systolic pressure, with a lower central pulse pressure, indicating increased pulse pressure amplification. Central blood pressure and measures of arterial stiffness like augmentation pressure were more strongly correlated with age and showed the effects of antihypertensive drugs better than brachial pressure measurements.

2. PULSE WAVE ANALYSIS, PULSE WAVE
VELOCITY AND CENTRAL BLOOD PRESSURE
EUROPEAN HYPERTENSION EXELLENCE CENTER
BAHRAIN SPECIALIST HOSPITAL

3. Scheme

4. Measurement of the BP
en.wikipedia.org/wiki/Korotkoff_souWikipedia

5. Transportation in 1900

6. Telecommunication and Mail 1900

8. CARDIAC CYCLE AND PRESSURE ALTERATION

15. Aorta and Central Arteries
INCIDENT WAVE
REFLECTIVE WAVE

16. 18
Physiology - Pressure Wave Reflection at the Heart
Figure 2

17. 19
Pressure Wave Reflection at the Heart
Figure 3

18. 20
Key Central pressure parameters.
S P
AP
PP
DP
 Systolic pressure (SP)
 Diastolic pressure (DP)
 Central Pulse Pressure (PP)
 Augmented pressure (AP)
“measure of the energy “wasted”
by the heart due to the reflected
wave”
 AIx (= AP/PP)
“composite measure of the
magnitude of wave reflection and
arterial stiffness”

19. 21
Pressure Wave Reflection at the Heart
Figure 5

20. Faster reflected time.
Added to systole

21. Schematic representation of pulse pressure amplification.
Oliver J J , and Webb D J Arterioscler Thromb Vasc Biol. 2003;23:554-566
Copyright © American Heart Association, Inc. All rights reserved.

22. Aging and changes in the pulse wave

26. Central Pressure shows the effects of Drug therapy masked by
31
 In the CAFE study of over 2,000
patients, brachial blood
pressure was controlled in both
study arms
 But the ACE/ CCB arm had up
lower central BP and 30% less
CV events than the beta blocker
arm.
 Augmented Pressure was
reduced by the ACE/ CCB but
not by the beta blocker.
 Brachial pressure does not
measure arterial stiffness
Brachial Pressure
Williams B et al., Circulation 2006; 113: 1213-25

34. Patient with CKD IV

38. BSH study on PWA and Central BP

39. BSH study on PWA and Central BP

40. BSH study on PWA and Central BP
Pressure Brachial (SE) Central (SE) p
Systolic 136 (1.2) 121.8(1.10 <0.0001
Diastolic 83(0.8) 84(0.8) < 0.0001
MAP 100.9 (0.8) 100(0.9) < 0.0001
Pulse pressure 52.7(1) 37.2(0.8) <0.0001

41. Regression of the Augmentation Pressure
RR 0.42

42. Univariate correlation for the Augmentation Pressure
Variables Corr. Coeff. P
Age 0.89 0.0001
Gender 0.166 0.015
BMI 0.327 0.0001
Brachial syst. 0.46 0.0001
Brachial diast. -0.058 0.39
Brachial Pulse Pres. 0.633 0.0001
Brachial MAP 0.18 0006
Pulse Rate -0.2 0.002
Central syst. 0.55 0.0001
Central diast. -0.043 0.5
Central Pulse Pres. 0.79 0.0001
Central MAP 0.216 0.001

43. Mulitvariate Regression of the Augmentation
Pressure. RR 0.92

44. Regression correlation for the Augmentation
pressure Index. RR 0.81

45. Conclusion